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系統識別號 U0026-2212201416210000
論文名稱(中文) 執行功能對慢性期創傷性腦傷患者之創傷後成長的影響
論文名稱(英文) Effects of Executive Functions on Posttraumatic Growth in Chronic Traumatic Brain Injury
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 103
學期 1
出版年 103
研究生(中文) 郭嘉珉
研究生(英文) Chia-Min Kuo
學號 S86001022
學位類別 碩士
語文別 中文
論文頁數 118頁
口試委員 指導教授-郭乃文
口試委員-余睿羚
口試委員-郭進榮
中文關鍵字 創傷性腦傷  執行功能  創傷後成長因子 
英文關鍵字 Traumatic brain injury  Executive function  Posttraumatic growth 
學科別分類
中文摘要 目的:創傷性腦傷(Traumatic brain injury, TBI)後遺症包括生理、認知、情緒、行為、社會功能以及人格改變等,影響人際、婚姻、工作和生活品質不佳。創傷後成長(posttraumatic growth, PTG)為經歷創傷事件後,主觀經驗到的正向心理改變。過去研究指出執行功能(executive function, EF)可能是影響TBI患者傷後適應的主要因素,但未分析不同EF部件之重要性為何,因此本研究欲探討各EF部件對PTG的影響。

方法:本研究通過人體試驗委員會核准,受試者來自南部某醫學中心,以該院民國100年度符合國際疾病分類診斷碼(International Classification of Diseases Ninth Revision, ICD-9)432.1;800-801.9;803-804.9;850-854.19;959.0-959.09;989.9;959.9之頭部損傷患者共1152人,採病歷回溯方式得到人口學與疾病背景,排除非TBI、已死亡、未滿12歲、發展遲緩、神經學病史、失語症、精神病史及物質濫用史,剩餘521位TBI患者逐一進行電訪追蹤並邀請參與研究,無法聯繫81人、無意思能力7人、拒絕102人、願意電訪但拒絕衡鑑259人,參與研究者共72人,病歷檢查排除5人,共67人進行結果分析,其中包含41位男性和26位女性,年齡分佈為16-65歲,腦傷嚴重度輕度53人、中度5人、重度9人,平均腦傷後時間為2年。研究工具有EF測驗與PTG因子量表二類,EF測驗包含衝動抑制、工作記憶、認知彈性及計劃監控四種部件,PTG因子量表包含新可能性、行動力、資源力及心靈力四種因子,研究者將患者EF測驗結果分為較佳與較不佳組,以獨立樣本t檢定檢驗兩組在PTG因子量表中的成長差異。

結果:結果發現患者認知彈性和日常生活語文性工作記憶會受其教育程度的影響,而語言與非語言工作記憶會受年齡的影響。67位患者中,有57%至79%的人在PTG因子量表上呈現成長。EF部件當中,衝動抑制影響較多的行動力、資源力及新可能性成長,認知彈性和工作記憶影響較多的新可能性成長,計劃監控則不影響成長。

結論:衝動抑制、認知彈性及工作記憶功能可影響慢性期TBI患者較多PTG,且不同EF可能影響不同PTG,故強化TBI患者之EF為促進PTG的可行途徑,此結果可作為選擇治療方式之參考。
英文摘要 Traumatic brain injury has many potential sequelae that can change patient’s physical, cognitive, emotional, behavioral, social function and personality. Research has indicated that executive functions are probably one of the major factors that affect the adaptation of the traumatic brain injury patients to life after the injury, but research did not to explore the importance of different executive function component. This study aims at investigate the relationship between different executive function and posttraumatic growth in chronic traumatic brain injury patients. 67 traumatic brain injury patients from a medical center in Tainan City, after taking the executive function test (including inhibition, working memory, cognitive flexibility, and planning) and posttraumatic growth inventory (including new possibility, active power, resources power and mind power), they were divided into preferred and less preferred groups according to the executive function test results, to which an independent samples t test is given to examine the differences between the two groups in terms of different posttraumatic growth factors. Inhibition, cognitive flexibility, and serial order working memory can have great effects on the condition of posttraumatic growth factors that are present in traumatic brain injury patients after two years, and different EFs may affect different posttraumatic growth factors. This finding can be used as the reference choice of neuropsychological treatment and rehabilitation.
論文目次 第一章 緒論 1
第一節、研究動機 1
第二節、文獻回顧 2
一、 創傷性腦傷患者的適應問題 2
(一) 創傷性腦傷之定義 2
(二) 創傷性腦傷之嚴重度指標 3
(三) 創傷性腦傷之後遺症與適應問題 4
二、創傷後成長的定義與機制 6
(一) 創傷後成長之定義與內涵 6
(二) 創傷後成長的測量 8
(三) 創傷後成長之理論與機制 8
三、創傷性腦傷患者的創傷後成長 16
(一) 腦傷患者的創傷後成長現象 16
(二) 影響創傷性腦傷患者創傷後成長的因素 17
四、執行功能與創傷後成長 20
(一) 執行功能定義 20
(二) 執行功能與額葉 22
(三) 執行功能於創傷後成長之角色 23
第三節、研究目的與假設 26
第二章 研究方法 27
第一節、研究流程 27
第二節、研究對象 29
第三節、研究工具 31
第四節、資料分析 43
第三章 研究結果 44
第一節、人口學變項與受傷時神經學變項分析 44
一、受訪組和拒訪組之人口學與受傷時神經學變項差異 44
二、參與研究組和拒絕參與研究組之人口學與受傷時神經學變項差異 45
第二節、執行功能部件分組分析 46
一、衝動抑制部件分組分析 46
二、認知彈性部件分組分析 47
三、計劃監控部件分組分析 48
四、工作記憶部件分組分析 49
五、自我報告之執行功能分組分析 50
六、執行功能較佳組與較不佳組人口學與受傷時神經學變項差異 52
第三節、創傷後成長因子間相關分析與創傷後成長變化分析 58
一、創傷後成長因子間相關分析 58
二、創傷後成長變化分析 58
第四節、兩組TBI患者創傷後成長因子與成長變化分析 61
一、兩組TBI患者創傷後成長因子差異分析 61
二、兩組TBI患者住院至今創傷後成長變化差異分析 71
三、兩組TBI患者過去至今創傷後成長變化差異分析 81
第五節、創傷後成長因子與總成長變化相關分析 91
第四章 討論與建議 92
第一節、結果與討論 92
第二節、研究限制 94
參考文獻 96
附錄一、創傷後成長因子量表 113
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